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“Please Let Me Die”

Euthanasia- The Right to Die:

Some consideration of bioethical issues at the end of life

by Dr Alex Tang

 

1.                   Introduction

A 56 years old woman has advanced cancer of the cervix. The cancer has spread to her lungs and bones. She has difficulty in breathing and is in severe continuous pain. She is unable to sleep and unable to eat. Both she and her husband knew that her death is inevitable. She wants the doctor to give her something to help her to die.

A young man of twenty was involved in a motor vehicle accident when he drove his car into the back of a stationary lorry. He substained multiple fractures and his skull was crushed. It took the neurosurgeon 6 hours to remove the bone fragments and evacuate the blood clots from his brain. During the surgery his heart stopped three times and he has to be resusitated. After the surgery, he was not able to breath and was put on a mechanical ventilator. That was one month ago. He is still on the ventilator. Clinically the doctors has classified him as ‘brain dead’. His parents wants the doctors to switch off the machines and let their son die.

A baby was born to a young couple. Unfortunately the baby was born without a brain (anencephaly). The doctor asked the parents whether they want to feed the baby or to let it starve to death.

A 70 years old man, once a powerful CEO of a multinational company, has Alzheimer’s disease. He is bedridden and totally dependent. He needs constant nursing care. There is not a shadow left of his former self. His mind has left his body. His wife of 40 years cannot bear to see her husband in this condition anymore. She request for help to let her husband ‘die in peace’.

 

Euthanasia or ‘mercy killing’ will become important as an issue as medical technology improves. With improvement in medical technology, there is improved health. Unfortunately the dark side of medical technology is that it also prolongs death. It  promote a feeling that we have lost control of our life and even our death. More and more people are feeling the need to regain control of the way they will be treated when they are terminally ill or when incapacitated, unable to make decisions. They want to die with dignity, not in some sterile hospital environments, surrounded by impersonal machines and monitors. Some will want to decide on the when and how of their dying. And they want their doctors to help them to die – physician assisted suicide or euthanasia.

McCormick observes that in our global society, there are five cultural trends which will cause the society to accept physician-assisted suicide: (1) the absolutisation of autonomy without considering whether the choices are good or bad, and the consequent intolerance of dependence on others,(2) the secularization of medicine which has divorced the profession from its moral tradition and has made it into a business,(3) the inadequate management of pain,(4) the nutrition-hydration debate and the distinction between killing and letting to die, and (5)the financial pressures of health care.[1]

2.                   Euthanasia Today

On December 2000, the Dutch lower house of parliament voted to become the first country in the world to legalise euthanasia. But the fight for the ‘right to die’ began long before that. In 1935, the Euthanasia Society of England was formed. Its objectives were twofold. Firstly, it was to convince the public that people suffering severely from fatal, terminal illness should be allowed a painless death if they request it and secondly, to promote legislation to that end. Despite the society’s effort, both 1936 and 1969 bills to legalise euthanasia were defeated in the House of Lords.

The Euthanasia Society of America was formed in 1938. Public opinion in the United States has generally been against euthanasia until recently. The publicity given to Dr. Kevorkian[2], and another to the book ‘Final Exit’[3] polarised their views towards euthanasia and galvanised many towards action. The Hemlock Society is very active in the United States, lobbying for the euthanasia cause.

Janet Adkins was fifty-four years old when she was diagnosed to have the early stages of Alzheimer’s disease. When informed about the course of the disease, she decided she did not want to live for years in this progressive, deteriorating condition. She decided to kill herself but she wanted her death to be painless and dignified. She sought the help of Dr. Jack Kevorkian, a pathologist from Michigan. On June 4, 1990 Dr.Kevorkian hooked her up to a cardiac monitor and an intravenous line. Janet Adkins pushed a button that released a lethal dose of medication, which killed her in 5 minutes. A murder charge was filed against Dr. Kevorkian but it was dismissed because the law of State of Michigan in the United States was vague against assisted suicide.

Euthanasia was legalised in the Northern Territory of Australia in July 1996 but the legislation was overturned by the Australian Parliament on March 24 after four patients have died.[4] Northern Territory have a population of only 150,000. Many of these are Aborigines. This bill was blocked by an interesting alliance of the ‘three As’ – the Australian Medical Association, the Anglican Church and the Aborigines.

3.                   What is Suicide?

3.1               Suicide

Suicide is the act of intentionally taking one’s life and is distinguished from natural death. There may be many reasons why it is done; such as to end one’s suffering, to avert financial ruins and to escape unbearable pain. Where there is no intention to end one’s life, there is no suicide. Thus those who risk their life in order to save others or those who refuse to renounce their faith knowing that this will mean their death do not commit suicide when they die as a result of this action because they do not explicitly intend their own deaths.[5]

3.2               Assisted Suicide

Assisted suicide occurs when one person intentionally gives another the means or opportunity to take his or her own life at the latter’s request often to relieve the person’s pain and suffering. For example, if a wife were to give her husband, who was terminally ill with cancer of the colon and in severe pain, a large quantity of poison at his request, this would be assisted suicide.

3.3               Physician Assisted Suicide

Physician Assisted Suicide occurs when a physician helps a person take his or her own life by giving advice, writing a prescription for lethal medication, or assisting the individual with some device which allows the person to take his or her own life. The physician lends expertise, the person does the act.[6]

For instance if a physician were to give a patient with a terminal condition who requested it a prescription for a large dose of barbiturates, knowing that the patient use the medication to commit suicide, this would be physician-assisted suicide.

4.         What is Euthanasia?

Euthanasia is a term that has not been used consistently. In classical Greek, it means “good death.”  In modern usage, it has taken a different, more specific meaning. Euthanasia has come ‘to mean that one person intentionally causes the death of another who is terminally or seriously ill, often to end the latter’s pain and suffering’

4.1   Active Euthanasia

Usually when euthanasia is mentioned, it is meant active euthanasia i.e. with intention to cause death, an action was taken. For example if a father were to inject his son, who is in great agony as he was dying, with a lethal dose of a drug in order to end his son’s suffering, this will be active euthanasia.

4.2   Passive Euthanasia

Passive euthanasia is used to describe the action of withdrawing and withholding treatment with the results that death occurs as it would as a natural consequence of the disease process.

4.3   Involuntary Euthanasia

Involuntary euthanasia is a compassionate act to end the life of a patient who is perceived to be suffering and could make a voluntary request, but has not done so. For example, if the same man with end stage lung cancer who wish to live as long as possible were given an overdose of barbiturate without his permission by his friend, the nurse who felt sorry for him, this will be involuntary euthanasia.

4.4   Non Voluntary Euthanasia

Non voluntary euthanasia occurs when another person, out of compassion, does an action with the intention of ending the life of a suffering patient where the patient is unable to make a voluntary request (e.g. an unconscious, retarded or demented adult; an infant or child). For example, if a man with advanced Alzheimer’s disease and in great distress had his life taken by her daughter, this would be non-voluntary euthanasia.

            It is important to differentiate the types of euthanasia because there are certain legal and ethical considerations involved. Active, involuntary and non-voluntary euthanasia involves an action performed with an intent to end the life of an individual. It is active.

Passive euthanasia is withholding or not continuing treatment when the doctors decide that the course of treatment will no longer work.

 

5         Euthanasia and the Bible

As in our study of abortion, the Bible is silent on the subject of euthanasia. As euthanasia can be considered a form of suicide, we shall do a short survey of the suicides in the Bible. There are seven incidents of suicides in the Scriptures.

5.1   Suicide in the Bible

5.1.1          Suicide of Abimelech

The first chronologically mentioned is Abimelech. After capturing the city of Thebez, he attacked a fortified tower in the centre of the city. The Old Testament noted “ Abimelech went to the tower and stormed it. But as he approached the entrance to the tower to set it on fire, a woman dropped an upper millstone on his head and cracked his skull. Hurriedly he called to his armor-bearer, “Draw your sword and kill me, so that they can’t say, ‘A woman killed him’.” So his servant ran him through, and he died.” (Judges 9:52-54). Scripture neither approves nor disapproves of this act of assisted suicide. It was noted as a fitting end to an evil man. “Thus God repaid the wickedness that Abimelech has done to his father by murdering his seventy brothers.” (Judges 9:56).

5.1.2          Suicide of Samson

The next suicide though arguably as there was a good cause and with divine sanction, was that of Samson. “Then Samson reached towards the two central pillars on which the temple stood. Bracing himself against them, his right hand on one and his left hand on the other, Samson said, “Let me die with the Philistines!” Then he pushed with all his might, and down came the temple on the rulers and all the people in it. Thus he killed many more when he died than while he lived” (Judges 16: 29-30) Scripture passed no judgement on his act of suicide.

5.1.3          Suicide of Saul and his armour bearer

The suicide of Saul and his armour bearer elicit more comment.

‘The fighting grew fierce around Saul, and when the archers overtook him, they wounded him critically. Saul said to his armor-bearer, Draw your sword and run me through, or these uncircumcised fellows will come and run me through and abuse me”. But his armor-bearer was terrified and would not do it; so Saul took his own sword and fell on it. When the armor-bearer  saw that Saul was dead, he too fell on his own sword and died with him.’  (1Samuel 31: 3-5).

Saul is condemned in 1 Chronicles 10:13-14, Saul died because he was unfaithful to the Lord; he did not keep the word of the Lord and even consulted a medium for guidance, and did not inquire of the Lord. So the Lord put him to death and turned the kingdom over to David son of Jesse.

Even though Saul killed himself by his own sword, the chronicler noted that God himself killed Saul for his unfaithfulness. His armor-bearer chooses to die with his king, an example of suicide by identification. There was no comment on it in the Scriptures.

5.1.4          Suicide of Ahithopel

Ahithophel was King David’s counsellor. He became Absalom’s when Absalom rebelled against his father. David prayed that God would turn Ahithphel’s counsel into foolishness (2 Samuel 15:31b). When Ahithophel found that his advice was ignored by Absalom, he hanged himself.(2 Sam 17:23). Again, there was no comment in the Scriptures about his actions.

5.1.5          Suicide of Zimri

Zimri came to the throne of Israel by assassination. The Israelites rebelled and besieged his city of Tirzah. “When Zimri saw that the city was taken, he went into the citadel of the royal palace and set the palace on fire around him. So he died, because the sins he had committed, doing evil in the eyes of the Lord and walking in the ways of Jeroboam and in the sin he has committed and had caused Israel to commit.” (1Kings 16:18-20). Here it was noted that his death was judgement for his sins.

5.1.6          Suicide of Judas Iscariot

Judas Iscariot was the only suicide mentioned in the New Testament. When Judas saw that Jesus was condemned, he was filled with remorse and tried to return the money. Then he went and hanged himself. (Matt 27:3-5) There was no further comment on Judas in the Scripture, except that his apostleship was given to Matthias (Acts 1: 23-26).

            It is interesting to note that in this brief survey of the seven suicides recorded in the Scriptures; the suicides of Abimelech, Saul and Zimri were recorded as direct judgement of God on their sins, even going as far as to say God killed Saul. The Scriptures were silent on the other four suicides, although the silence of Scripture is not the basis for positive argument, especially when the ignoble context in each case speaks for themselves.

5.2   Bible and the Sanctity of Life

5.2.1          Human Dignity comes from God.

Human life reflects the very life of God. We are created in the image of God (Gen 1:26-27), so our dignity and God’s are closely related. “Whosoever sheds the blood of man, by man shall his blood be shed: for God made man in his own image” (Gen 9:6). Human life is a gift from God. In response, we should approach this life with gratitude, thanksgiving and deep responsibility.

5.2.2          All Human Life has Equal Dignity

In Genesis 1:27: “So God created man in his own image, in the image of God he created him; male and female he created them.” Men and women bear the same dignity and this applies to all of mankind of all ages, sex, race and conditions. However incapacitated, mentally retarded, chronically ill, physically dependent or in a persistent vegetative state, they bear that dignity and has equal claims on us.

5.2.3          “Thou shalt not kill”

The sixth commandment “Thou shalt not kill” (Ex 20:13; Dt 5:17) has its roots in the Creation’s narrative:- “Let us make man in our own image”(Gen 1:26) and in the Noahic Convenant’s “Whosoever sheds the blood of man, by man shall his blood be shed”(Gen 9:6). Man, being made in the image of God, is not to be intentionally killed. Ratsach is the Hebrew word translated as ‘kill’ in the commandment. It is similar to the Greek phoneuo, which means ‘murder’. Hence the sixth commandment forbids murder or ‘unauthorised, intentional or hostile killing of one human being by another’. It is because of this that many Christians will allow exceptions to this commandment such as martyrdom, war and capital punishment. Such exceptions can also be inferred from the Scriptures.

5.2.4          Love your Neighbour. 

Jesus summarised the Commandments as ‘Love the Lord your God with all your heart and with all your soul and with all your mind and with all your strength’. The second is this: ‘Love your neighbour as yourself’. (Mk 12:30-31). Christians are called to love their neighbours. And this included taking care of each other and looking out for each other. It does not include helping each other to die, though Biblical Christian ‘situation ethicists’ may argue otherwise in the name of a new metaphysically contentless definition of ‘love’ when that neighbour is in great suffering.

5.3   Bible and the Right to Die (Autonomy)

Autonomy, not in the absolute sense but in the sense of a God-given ‘human responsibility’ as a paradoxical Biblical counterpoint to Divine Sovereignty, is the main issue of the argument for the Right-to-Die. Christians have distinctive, principled and compelling reasons for taking the claims of autonomy rooted in our God-given Free Will with great seriousness. We are created in the image and likeness of God (Gen 1:26-27). An  essential part of that image is our ability to think and to choose. Hans Kung, observes that life is”…a human task and thus made our responsibility….[God] wants to have human beings, in his image, as free, responsible partners”.[7] Hence we have the freedom to choose our own end. Ethical liberalism too attributes a supreme value to the individual’s freedom and rights.

The dominant value upheld by the principle of autonomy is self-determination. It is such a supreme value because it means that you and I can live according to our own conception of the good life. I am ultimately responsible for my life and you are for yours. The human dignity attached to the freedom of self-determination demands respect for the freedom to choose and to control not only life but also how and when we die. The “right to die” and “death with dignity” in this view may be translated as something like the following: “It’s my body; it’s my freedom; it’s my life; it’s my death. Let me have control.” Absolutizing autonomy in this way makes “death with dignity” mean that each of us should be able to determine at what time, in what way, and by whose hand we will die. While no ones doubts that self-determination is an important value, the question in the euthanasia debate is, “ How far does autonomy extend?”[8]

The Scriptural model for human autonomy, self determination and human responsibility is portrayed in Genesis 2:19:

 Now the Lord God has formed out of the ground all the beasts of

the field and all the birds of the air. He brought them to the man to see

what he would name them; whatever the man called each living creature,

that was its name. So the man gave names to all the livestock, the birds of

the air and all the beasts of the field.

As Hebrew scholars have noted, to ‘name’ something is not simply to label it; it is to give it a meaning and order it in the nature of things. Hence, Adam is called upon to continue the creation by bringing order into being, rather than simply replicating preordained orders.[9] This is also the principle of stewardship.

The fundamental distinction between the Creator and the created (His creation) sets limits to the freedom and scope of our stewardship. The limitations to human autonomy or self determination is found earlier in Genesis 2:15-17:

The Lord God took the man and put him to work in the Garden of Eden to work it and take care of it. And the Lord God commanded the man, “You are free to eat from any tree in the garden; but you must not eat from the tree of the knowledge of good and evil, for when you eat of it you will surely die”.

The story asserts a fundamental conviction of biblical faith that from the very beginning human freedom over life was limited or proscribed. God alone has sovereignty over life and death. The end of human life is not subject to a person’s free judgement. Our freedom does not extend to absolute dominion. Absolute dominion is an exclusively divine prerogative. This is called the principle of sovereignty.[10]

The principles of divine sovereignty and human stewardship and responsibility argues against unlimited autonomy in the discussion about euthanasia. In his encyclical Veritatis Splendor, Pope John Paul II rejected claims of personal autonomy and the belief that human beings can do what they want with their bodies.[11] (cf 1 Cor 6:19-20 : “Do you not know that your body is a temple of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were brought at a price. Therefore honor God with your body.”)

      In this brief survey of the Bible, it can be noted that Bible is silent on the subject on euthanasia. Of the various suicides in the Bible, the biblical authors emphasised the consequences leading to the act rather than commenting on the act itself.  But the Bible does give us certain principles to help us think through the issue of euthanasia.

 First is the principle of the sanctity of human life. Second is that there is no unlimited autonomy. Life is a gift from God and human beings do not have the right to take away this gift.

6         Why Euthanasia?

Fear is a strong emotion. An emotion that will force anyone to consider ending his or her own life must be necessarily strong. The post modern society is a society built on fear  – fear of uncertainty, insecurity and hopelessness. Proponent for euthanasia such as Derek Humphry[12] of the Hemlock Society and ethicist such as Peter Singer[13] pick on this fear when they argue for euthanasia.

6.1   Fear of Prolonged Dying

Medical progress has created an interesting phenomenon – dying in bits and pieces and in stages. One of our fears is that medical technology and treatment methods will prolong our dying, long after it was decided that our condition is terminal and hopeless. Karen Quinlan, a severely brain damaged lady in irreversible coma, took seven years to die after the ventilator was removed. Seven years in which she never regained consciousness. Seven years of emotional pain and financial burden on her family. All this could have been avoided, others say by a single lethal injection. We dread to be helpless, to know that our bodies are deteriorating, our organs are failing and we are becoming more dependent. Especially when we are told by the best medical experts around that there is no hope for recovery, only steady deterioration.

6.2   Fear of Dying in the Cold

Another fear is the institutionalisation of dying. Dying has become a cold, clinical process. The overwhelming majority of people especially those in the developed world die in institutional settings, such as nursing homes and hospitals. While some of these offer care, safety and familiar personnel and surroundings, others represent sterile, indifferent and sometimes even hostile and unfriendly environments. It is this inhuman side of medicine that is frightening. Such death is comparable to dying ‘in the cold’; by the roadside, uncared for and unloved, without dignity and no different from an animal.  It is also this fear that convinces many that the option for euthanasia should be available.

6.3   Fear of Uncontrolled Pain

Much pain accompanies many terminal events, especially cancers. As the population ages, the incidence of cancers and degenerative disorders increase. Though pain management in palliative care has improved tremendously in the last few years, it is still not ideal and has its limitations.

Pain management is dependent on the expertise and attitude of the attending physicians and supporting personnel. The attitude and belief system of the attending physician and supporting personnel will influence the way they treat a patient. They may believe that in some way, suffering is good for the soul and may unconsciously not optimise the level of the analgesics. Physicians are trained to cure, to win and they may have trouble accepting a case of terminal illness. Many physicians feel a sense of failure and how they react to their feelings may affect their treatment of their patient. They may be indifferent to the needs of their patients, including their pain and even ignore them totally. As a result, many patients suffer from inadequate pain control.

The pain may be controlled but the patient may be in a narcotic haze and have a ‘dopy’ look. Many people are not willing to exchange their awareness and dignity for control of their pain. There are many that have lived through life without any dependence on narcotics. To them it is insulting that their last days be dependent on such drugs.

Such people, with their fear of inadequate pain management would appreciate the option of euthanasia when they can arrange for a dignified death.

6.4   Fear of Loss of Control

Personal autonomy or self-determination is the cornerstone of this post-modern world. We would like full control of our lives. This will include the desire to choose the time and manner of one’s death.

In his book, Tuesdays with Morrie, Mitch Albom describes the last few months he spent with his old professor, Morrie Schwartz. Morrie was suffering from amyotrophic lateral sclerosis (ALS), a slow unremitting degenerative disorder. The book started with a man who enjoyed dancing and ended with him incontinent in bed before he died.[14]

This is the fear of many of us. The fear of senility and embarassing dependency. To get a disease like ALS or Alzheimer’s and deteriorate slowly and there is nothing we can do about it. Better to kill oneself with a lethal overdose than to suffer the indignity of slow deterioration. At least we can choose when to die. When we can no longer serve God or others by remaining alive, is it wrong to exercise our freedom of choice to bring about our own death or to ask others to do so for us?

6.5   Fear of Being a Burden

Many of us fear being a burden to others. The burden may be financial, emotional, physical or spiritual. Hence we would like to have an option of removing that burden ourselves when the right time and place comes.

Many of us fear becoming a physical and emotional burden to our spouses, children or relatives when we become chronically ill, debilitated and dependent. Malaysia is a rapidly developing country. Most young couples do not have the time or the resources to take care of the sick in their household. We hear of parents being shuttled from children to children on a two-week rotation. This is when they are well. What if they are very ill and dependent but do not need hospitalisation. Would they be made to feel welcome? Would their sense of self worth still be intact? Would they consider euthanasia as an appropriate Christian act of love?

6.6   Fear of Isolation and Depression

Dr. Kenneth Schemmer notes:

Many aspects of dying produce loneliness for the patient.

·          The sickness itself usually causes both patient and visitor to withdraw from each other.

·          The delivery of medical care, especially by high-tech procedures, often places physical barriers between the patient and the care-givers.

·          For the patient, the whole process of dying is isolating. He or she quits working, quits social activities, spends less time with hobbies, hasn’t the strength to maintain daily activities with family, and his or her time become continually more consumed with caring for himself or herself than for others.

·         Friends find it increasingly more difficult to arrange times to visit the patient, and when they do, he or she is less interested in them. Friends lose interest in visiting. So the patient loses more interest in them and his or her surroundings.[15]

Increasing loneliness is a reality in chronic and terminal illness. In a society that fears loneliness, where there is always noise and people and activity. To be alone is a terrifying experience.

Depression is another emotion we fear. Depression is not the usual ups and downs we feel in our daily life but a persistent feeling of despair. A depressed person has a depressed mood that may last weeks or months, suffering loss of pleasure and interest in things previously enjoyed, feelings of worthlessness and excessive guilt, sluggish and slowed down (with psychomotor retardation) or chronically agitated, fatigued, troubled in thinking and concentrating, with changes in weight and sleep pattern and plagued by recurrent thoughts of death.

     All of these fears are real. As our bodies age, as our health deteriorates and as our ability to lead an independent lifestyle are challenged, these fears will surface. And these fear will drive many to seek a way out – when the time comes, they want to have an option to opt out of life, to kill themselves.

 

7         Alternatives to Euthanasia

The Church in its stand against euthanasia must be able to offer alternatives to euthanasia. Otherwise it will have failed in its mandate to help its neighbour and to protect the weak and helpless. In his teaching on the parable of the sheep and goats, Jesus said that those who follow His mandate will be blessed by His Father and receive an inheritance. The mandate is,

‘For I was hungry, and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’ (Matthew 26: 35-36)

And the Church must be a powerful voice in educating society that there are alternatives to euthanasia. It must show to society that all those fears that drives someone to seek euthanasia can be overcome.

7.1   Pain Control

Total pain management involves four areas: physical, emotional, social and spiritual pain. There has been much progress made in the management of pain. Today we have ‘pain control’ teams in many hospitals and ‘pain control’ nurses whose job is to help patient control their pain. It has been claimed that, in the setting of widespread cancer, although more than half the patients will experience pain, their pain is manageable by oral administration of opioids alone in 70-80% of cases.

New pain control methods include radiation therapy, nerve blocks (including spino-thalamic tractotomy), NSAID, transcutaneous electric nerve stimulation and direct spinal cord (dorsal column) stimulation. There are also developments in non-pharmacological methods such as distraction, art and music therapy and relaxation. One of the most useful pain control technologies to date is the Patient Controlled Analgesia PCA (a pump which can deliver a continuous infusion of drugs such as morphine, as well as allow patient-activated doses for breakthrough pain). PCA allows the patient to have a continuous infusion of analgesic as well as a button which allows the patient to press for a single increased dose in the case of worsening pain. Studies have actually shown that PCA may actually lower the amount of medication administrated to patients, while providing them with a safe and effective way to have more control over their treatment. It is a great relief to a patient to know that they have available the means to ease their pain and that they are able to do something about it.

7.2   Palliative Care and Hospice

The World Health Organisation has defined palliative care as being ‘ the active and appropriate care of patients whose disease is no longer curable. It affirms life…..regards dying as a normal process…and …neither hastens nor postpones death.’ The emphasis is on caring.

Modern hospice care is a remarkable recent development. The Hospice organisation was founded in London in 1967 by Dr. Cicely Saunders[16] at Saint Christopher’s Hospice and imported to the United States the next year by Florena Wald, then dean of Yale University’s School of Nursing. Its subsequent rapid growth is a testimony to the urgent need of helping patient to ease their dying process as opposed to the use of medical technology to keep them alive

The hospice philosophy encompasses more than the standard medical palliative care. It includes physical, psychological, social, and spiritual therapies. Physicians, nurses, counselors, clergy, social workers, occupational and physical therapists, and volunteers work as a team to provide various hospice services.

7.3   Financial Support

We are well aware of how important financial planning is. Many of us do financial planning for our retirement, making sure we have enough money to see us through our ‘golden’ years. Yet few of us plan for medical treatment. Some of us do have a medical hospitalisation insurance plan that pays us a certain sum of money when we are hospitalised for a certain number of days. Others have health benefit from their jobs. Yet how many of us prepare for a long period of hospitalisation or a regime of treatment that will cost us a large sum of money.

Cancer treatment regimes may last for 1-2 years and cost around  RM 200,000.00. A bone marrow transplant cost RM 250,000.00. Treatment costs of this nature can easily wipe out our retirement savings. We cannot depend on subsidised government healthcare. For example, if you are 55 years old, suffering from kidney failure and need daily haemodialysis, you will never get into a government dialysis program. The reason is that you will not get priority. A younger patient with a young family will get priority to get into the program over you. Hence there is a need to plan for major illnesses. There are a number of insurance schemes that cover major illnesses.It is good Christian stewardship to buy into one of these policies. Then in times of illness, we will not feel a financial burden and think of euthanasia as a way to save medical fees!

7.4   Church

The Church is a caring community and has much to offer as an alternative to euthanasia. People will not look to euthanasia as an option if their needs are being met and the church has a major role to play to meet their needs.

7.4.1          The Biblical Mandate to Care

The Church has a biblical mandate to care for the sick, the poor and the lonely. It will be in fulfilling this mandate that the Church will make a difference in the world. It is in following this mandate that the church can offer a viable alternative to euthanasia for the terminally ill.

7.4.2          Power of Faith and Hope

The Church has the power of faith and hope. Faith and hope to know that death is not the end but just a beginning of a new and wonderful experience. Hence death is not to be feared. Yet we are not to seek death but to continue our present life in faith until our allotted time is over. The Church also has power in the faith of a loving and caring God. The prophet Isaiah wrote. “ For the Lord comforts his people and will have compassion on his afflicted ones.”(Isaiah 49:13b). It is with this faith that the Church can help those suffering from terminal illness to bear their afflictions with fortitude.

7.4.3          Power of Prayer

The Church can draw on the power of prayer. James 5:14-16 states:

‘Is anyone of you sick? He should call the elders of the church to pray over him and anoint him with oil in the name of the Lord. And the prayer offered in faith will make the sick person well; the Lord will raise him up. If he has sinned, he will be forgiven. Therefore confess your sins to each other and pray for each other so that you may be healed. The prayer of a righteous man is powerful and effective.’

 

It is one of the great mysteries of the universe that God will listen and act upon the prayers of his people. The Church has a God given role to pray for the sick and those facing death. The Church will have failed in its mission if it does not pray for and with the sick and dying.

7.4.4          Power of Compassion and Empathy

The Church has the power of compassion and empathy for the sick and the dying. It should encourage us to face the limit of our mortality before the critical moments of imminent death when we face those hard choices of whether to treat or not to treat. The church should have more preaching on facing limits, living with mortality, suffering and death. Waiting for a funeral to address these issues is too late. The Church should also have educational program that helps people to stay well,

cope with stress and face death. Educational programs on death and dying should include the writing of living wills and discussing the issues of euthanasia. In making a right-for-life stand, the Church has not always been successful in teaching its members the reason for its stand.

The Church must be hospitable in the way it provides for members who can visit and communicate to the sick, the shut-ins (people who cannot leave their homes)  and the dying. They must be shown that they are worthy of respect, that their lives have meaning, and that they are not being isolated or abandoned. Suffering in those with chronic illnesses and as life ends is exacerbated for those who are unable to sustain relationship of any meaning and value. The loss of contact with others in any meaningful way spawns hopelessness and despair. Hence the ministry of visitation is especially important in the elderly, the sick and the dying. Everyone who has this contact with them must be conspicuously visible and keep company with them often, be willing to talk about what is important to them and to listen to their needs, fears, questions, and hope.  We must offer them emotional support and when necessary call in professional help.

7.4.5          Power of the Church’s Collective Resources and its Network

Finally, but not the least, the Church should use its collective resources and its network to champion for hospice care. Many learned theologians, physicians and ethicist have said much on the rightness and wrongness of euthanasia. The proponents of euthanasia often discuss on how to proceed with euthanasia and their proposed plan to lobby legislation. Opponents of euthanasia will write pages and pages on why euthanasia is morally wrong. Yet when it comes to what one is to do if one does not take up euthanasia, there is silence! How can you defend an issue if you do not offer solutions? Only a handful of authors offer alternatives to euthanasia and often in a cursory manner.

If the Church is to the champion of the right-to-life movement and to stand against euthanasia, it must be pro-active in hospice care. It is in  hospice care that we can offer a dignified death. It is in hospice care that we can overcome many of the fears that drive people to seek euthanasia.

8         Concluding Remarks

In the coming years, when the number of people in the older age group increases and when the healthcare budget of countries becomes smaller, euthanasia will become an important issue. People will seek euthanasia out of fear or necessity. Fear of prolonged dying, of dying in a cold institution, of feeling uncontrolled pain, of loss of control, of being a burden and of isolation and loneliness. The biblical principles of sanctity of human life and that there is no such thing as unlimited autonomy exclude the option of euthanasia. The Church has to offer viable alternatives to euthanasia. Only then can the Church fulfil its mandate to bring help to the poor, the sick and the dying.

Recommended reading

 

Larson, Edward and Admundsen, Darrel, A Different Death .( Downers Grove, IL :InterVarsity Press, 1998)

 

 

Soli Deo Gloria

Endnotes


[1] R.A. McCormick, “Physician-assisted suicide: flight from compassion”  in Christian Century v.108 (35) December 4, 1991 : 1132-1143

[2] Matt Bai, “Death Wish” in Newsweek December 7, 1998 p. 39-41 gives a good write-up on Jack Kervorkian. Dr. Kervorkian is a pathologist who invented a ‘suicide machine’ that helps patients commit suicide.

[3] Derek Humphry, Final Exit  (Eugene, OR : Hemlock Society, 1991) was published in 1991. It is a ‘do-it-yourself’ suicide manual. It was an immediate best seller. Joni Eareckson Tada described her reaction when she first watched Derek Humphry talking about the book on television and her observation on the book’s subsequent effect on Americans in her book When is It Right to Die (Grand Rapids, MI:Zondervan,1992)p. 26-37. Derek Humphry also highlights the success of his book, Final Exit in Dying With Dignity: Understanding Euthanasia (New York: Carol Publishing Group, 1992) p. 27-36.

[4] Christopher Zinn, “Australian voluntary euthanasia law is overturned” in British Medical Journal, vol 314, 5 April 1997:993

[5] Committee on Medical Ethics, Episcopal Diocese of Washington, Assisted Suicide and_Euthanasia : Christian Moral Perspectives, The Washington Report . Harrsburg,PA : Morehouse Publishing, 1997  p.11

[6] Definition of Physician-Assisted Suicide provided by the Christian Medical and Dental Society, USA. Christian Medical & Dental Society Ethical Statement, Physician Assisted Suicide cited in                                        http://www.cmds.org/Ethics/4_5.htm

[7] Hans Kung, “A Dignified Dying,” in Hans and Walter Jens, Dying with Dignity ( New York : Continuum, 1995) p. 26

[8] Richard M.Gula, Euthanasia : Moral and Pastoral Perspectives ( New York : Paulist Press, 1994) pp. 9-10

[9] Delwin Brown, To Set at Liberty : Christian Faith and Human Freedom (Maryknoll, N.Y. : Orbis Books, 1981) p 9,15,35,53 quoted in Sally B. Geis, & Donald E. Messer, How Shall We Die? : Helping Christians Debate Assisted Suicide (Nashville : Abington Press, 1997)  p.157

[10] Gula, op. cit. pp. 11-14

[11] Robin Gill, (ed), Euthanasia and the Churches :  Christian Ethics in Dialogue (New York : Cassell, 1998) p.33

[12] Derek Humphry, founder of the Hemlock Society, is a journalist and author who has spent the last twenty years campaigning for lawful physician-assisted dying to be an option for the terminally and hopelessly ill. He started this campaign in 1975 after the death of his first wife, Jean, from bone cancer, which had become so painful and distressing that she took her own life with his help.

[13]Peter Singer is the director of the Centre for Human Bioethics at Monash University in Victoria, Australia, and president of the International Society for Bioethics. Among his books are Embryo Experimentation (Cambridge: Cambridge University Press, 1990) and Rethinking Life and Death: The Collapse of Our Traditional Ethics (St. Martin Press, 1996).

[14] Mitch Albom, Tuesdays with Morrie (London: Warner Books, 1997). In this book, Mitch Albom describes the slow deterioration of his friend and their conversations. It is notable that in spite of his disease, Morrie did not talk about euthanasia or request for a quick end.

[15] Kenneth E. Schemmer, Between  Life and Death (Wheaton, IL : Victor Books, 1988) p. 148

[16] Dame Cicely Saunders had studied under Oxford scholar C.S.Lewis before World War II and travelled in Christian circles that included Dorothy L. Sayers. While serving as a nurse during the war and a social worker after it, Saunders become interested in the plight of the terminally ill and serving them became her ministry. She attended medical school to learn ways to control the pain of dying cancer patients and in 1967 founded the first modern hospice.

 

Bibliography

 

American Medical Association Judicial Council , Revised Opinion, Witholding or Withdrawing Life Prolonging Medical Treatment . (Chicago IL: American Medical Association, 1986)

Anderson, S.J., When Someone Wants to Die. (Downers Grove : InterVarsity Press,1988)

Beckwith, Francis and Geisler,Norman L., Matters of Life and Death . (Grand Rapids, MI : Baker Book House,1991)

Brand, Paul and Yancey, Philip, The Gift of Pain . (Grand Rapids, MI : Zondervan,  1993,1997)

______, Escape From Pain . (London : Christian Medical Fellowship, 1975,1977)

Beaucamp, Tom L., Intending Death : The Ethics of Assisted Suicide and Euthanasia  (Upper Saddle River, New Jersey: Prentice Hall, 1996)

Cameron, Nigel M. de S., The New Medicine : Life and Death After Hippocrates (Wheaton IL: Crossway Books, 1991)

Committee on Medical Ethics, Episcopal Diocese of Washington, Assisted Suicide and Euthanasia : Christian Moral Perspectives, The Washington Report .( Harrsburg, PA : Morehouse Publishing, 1999)

Cundiff, David, Euthanasia is Not the Answer : A Hospice Physician’s View  (Totowa, New Jersey: Humana Press, 1992)

Geis, Sally B. and Messer, Donald E., How Shall We Die .(Nashville : Abingdon Press,1997)

Geisler, Norman L., Christian Ethics : Options and Issues. (Grand Rapids, MI: Baker, 1990)

Gill, Robin, (ed), Euthanasia and the Churches.  (London : Cassell, 1998)

Gula, Richard M., Euthanasia : Moral and Pastoral Perspectives . (New York : Paulist Press, 1994)

Guroian, Vigen, Life’s Living toward Dying. (Grand Rapids, MI : Eerdmans, 1996)

Humphry, Derek, Dying With Dignity : Understanding Euthanasia . (New York N.Y. : Carol Publishing, 1992)

_______, Lawful Exit : The Limits of Freedom for Help in Dying . (New York N.Y. : Norris Lane Press, 1993)

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Koop, C. Everett, The Right To Live ; The Right To Die.(Wheaton, IL : Tyndale House Publisher, 1976)

_______, and Schaeffer, Francis A., Whatever Happened to The Human Race?  (Westchester, IL: Crossway Books, 1979,1983)

Kung, Hans,  “A Dignified Dying,” in Hans and Jens, Walter, Dying with Dignity  (New York : Continuum, 1995)

May, William F., Active Euthanasia and Health Care Reform . (Grand Rapids, MI :  Eerdmans, 1996)

Orr, Robert, Biebel, David and Schiedermayer, David, More Life and Death Decisions  (Grand Rapids, MI : Baker Books,1990)

Peck, M.Scott, Denial of the Soul : Spiritual and Medical Perspectives on Euthanasia and Mortality . (London : Simon & Schuster, 1997)

Report of the Task Force on Assisted Suicide to the 122nd Convention of the Episcopal  Diocese of Newark, January 27, 1996

Schemmer, Kenneth E., Between Life and Death : The Life-Support Dilemma  (Wheaton, IL : Victor Books, 1988)

Shelly, Judith Allen, Dilemma : A Nurse’s Guide for Making Ethical Decisions . (Downers Grove, IL : InterVarsity Press, 1980)

Stewart, Gary P., et al, Basic Questions on Suicide and Euthanasia : Are They Ever Right?  (Grand Rapids, MI : Kregel Publications, 1998)

________, Basic Questions on End of Life Decisions. (Grand Rapids MI : Kregel Publications,1998)

Saunders, Cicely, Baines, Mary and Dunlop,Robert, Living with Dying : A Guide to Palliative Care . (New York: Oxford University Press, 1995)

________, and Kastenbaum, Robert (eds), Hospice Care on the International Scene . (New  York: Springer Publishing Company, 1997)

Tada, Joni Eareckson. When Is It Right To Die? (Grand Rapids, MI : Zondervan,1992)

Twycross, R.G., The Dying Patient. (London : Christian Medical Fellowship, 1975)

Uhlmann, Michael M. (ed), Last Rights : Assisted Suicide and Euthanasia Debated   (Grand Rapids, MI : Eerdmans,1998)

Vere, Duncan, Should Christians support Voluntary Euthanasia? (London : Christian Medical Fellowship, 1971)

________, Voluntary Euthanasia- Is there an Alternative?  (London : Christian Medical  Fellowship Publication, 1971,1979)

 

 

 

|updated 25 February 2010|

 

 

 

 

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